Wednesday, December 12, 2012

#ONC2012 - Sen. Mark Warner remarks

Sen. Mark Warner (D-VA) addressed #ONC2012 on December 12, 2012. These are his comments and his introduction as taken from the full transcript.

Dr. Farzad Mostashari
>> Take your seats, we have special guest here, Senator Warner has been a true champion for the use of technology and innovation to solve our nation's toughest problems.

He's been entrepreneur, co-founder of telecommunication firm Nextel, and early investor in scores of early start-ups that have really transformed how business operates and so many different fields. Following that, he of course applied his considerable executive powers as Governor of the state of Virginia, one of the best run States when he was there, and then took his passion and talent to the United States Senate.

What I can tell you about the Senator is that when we talk about health IT like no other legislator I have ever met with, he gets it and he gets it at a level of depth, of clarity, of questioning that is truly remarkable and I think you will see that on full display here. Ladies and gentlemen, Senator Warner.


Sen. Mark Warner (D-VA)
>> Senator Warner: Thank you for that very generous introduction and thank you for all the good work that ONC is doing and this opportunity to bring folks from around the country to talk about the challenges and opportunities around health IT.

I know many of you are just trickling back from lunch, so layout two thoughts perfect we get -- I get into my presentation. My background before I was in politics, I was a cell phone guy, co-founder of Nextel, I am the only speaker and I guarantee you the only politician around that says even when I'm speaking, leave your cell phones on. (Laughter)

You know, you hear an annoying sound, I hear chaching. Leave it on. I've been in the Senate for three years now, 3-1/2 years, I guess, usual introduction is and Mark Warner has been a bipartisan guy dealing with debt and deficit, I can assure you while I am happy to be here, I would much rather be in that room with the President and Speaker making sure we don't go over the fiscal cliff. This shouldn't be as hard as it is playing out to be, but that issue, which dominates the news at this point, will clearly have ramifications, not only on the issue we're talking about today, but whether our economy is able to kind of move forward in the way that I hope it will.

Again, I PDP the opportunity to speak to you. I know that everyone in this room believes that health information technology can help us improve patient care, increase coordination amongst providers, hospitals and most importantly, start to reduce healthcare cost, not to diverge back to fiscal cliff issues, but as somebody who believes strongly that Medicare is one of our very important safety net providers, we just got to recognize a system right now where you pay in 114,000 of Medicare taxes over your lifetime of employ SXMENT get out $319,000 in healthcare services, that imbalance, which is going to continue to grow as we have an aging population and more and more people on entitlement and less and less folks in the work force paying in, mean that we can do all the age adjustment possible, but until we drive down the overall cost of health DLT care and make the delta smaller, we're not going to get things done.

I think the question is going to be and the question you have to address and I as a policy maker have to nudge you along on is whether we have the personal and political well to take this enormously powerful tool of healthcare IT and really allow it to be transformative. Whether we're going to be able to continue to push on Meaningful Use, which I will come back to in a while, not some mystical point in the future, but right now and one of the most important points I'm going to try to come back to today time and again is Meaningful Use is great, but without interoperability, you know, you really are not kind of creating the kind of comprehensive promise that healthcare IT indirectly providers and even more indirectly, consumers have been promised and the high-tech act is part of the stimulus, when we thought it was going to be 27 billion dollars in healthcare IT, now since those Meaningful Use payments may tick up toward north of 30 billion, that is some serious dough. The fact that we've spent out $10 billion that so far means we've got more to come, but it does mean that here we are four years after the stimulus and while progress has been made I think we have to put our foot on the accelerator even more and we have to recognize that it is going to require all of us to get into a little bit of discomfort zone if we're going to get this done.

I think there are three critical steps that we have to grapple with.

First, we need clear interoperability requirements amongst electronic medical record systems. And farzad, pitched me on what is going to happen in stage 2, I think that is a step forward, stage 2, but we've got to have an audit trail and be able to figure out and not just have this be an aspirational goal, but something that we can make sure is accomplishd and measured.

Second, we need to accelerate Meaningful Use. Not step away from that, but that Meaningful Use has to be tied in to clear interoperability standards.

And third, we need to establish long-term strategy for health IT, which means how do we have to align incentive inside the healthcare system to make sure health IT really works, right now and approximate I'll come to more of this in a moment, I don't think the economic incentives are truly aligned for health IT to work. As I mentioned, I'm a telecom guy, somebody that was in the wireless field, and I know analogizing wireless to health IT, we get into some problems. They are definitely not -- they are apples and oranges, but they are lessons we can learn.

I recall when I first got in the wireless industry back in the early '80s, the projections were that at the end of 35 years, not 10, not 20, but 35 years, a full 1% of Americans would have cell phones.  (Laughter)

Here we are about literally about about 30 years end and north of 300 million cell phones in the world and over 6 billion -- 300 million cell phones in America and 6 billion cell phones across the world. I would argue, one reason why that explosion took place was that before we -- before we built out all of the cool apps, the FCC did something that was very hard, they set very strict standards for interoperability so that all the systems that developed could all talk to each other, otherwise we could have ended up in the wireless world not unlike where we at least are in the healthcare IT world with lots of cool apps and lots of cool stand alone systems, but the ability to really exchange data information and communicate would have been seriously retarded.

So first and foremost, interoperability, now let me acknowledge that there are four areas where my analogy breaks down and there are four areas that I think are clearly challenging if we're going to get interoperability right.

First, because we department set interoperability standards first and because healthcare IT has been around for 30 plus years, we have enormous number of legacy healthcare systems.

Second, and what is different in healthcare than almost any other area is that HIPAA requirements while terribly important make this exchange extra ordinary important information about patients that providers, patients and others in the network need more difficult because very appropriate privacy concerns.

Third, even if we can get around the HIPAA challenges, we have I think enormous lack of economic incentives for those who are currently collecting the data to actually take what they view as proprietary and share it. And fourth, we have to recognize that unlike cell phone data or unlike internet use of almost any other information system, there is nothing as rapidly changing as both medical technology, medical procedures and connected to that, all of the complexity that goes along with billing.

Let me come back to each of these and touch on them for a moment. We actually in the phone world and in the computer networking world, let me acknowledge that there was a great deal of disagreement at the outset about how you could set common standards, one area, we got it right on overall cell phone systems, one reason why now only 30 years later or 25 years later from kind of the idea of common in building communications and wifi systems, that has been slower to adapt, we never got the equipment vendors to actually agree in that space on interoperability. But around EMRs, we've consequently had the fact that we've got these -- we've got this lack of compatibility, we need crystal clear front end requirements for systems. It is not enough to be simply able to send secure e-mails. We need to figure out in the next two year -- year or two, not the next five or 10, how to get equipment made by different vendors to allow for searches, transactions and for exchange of information between different vendors.

June 2012 New England Journal of medicine article found part the problem again is of course our legacy systems. The authors argued that the first electronic health record systems were created in 1966 in "most EHR vendors not only have failed to innovate, but don't even embrace existing modular architecture with interfaces that allow extension of product capabilities inadvertent uses of data and interoperability with other software." So when we got the New England journal of medicine acknowledging those have been in the market place for some time are not aligned at all, we are going to have to at some is point and again stage 2 is a step in the right direction, we need clear, clear interoperability standards.

Second, unlike credit cards, where we've again got some analogy or mobile technologies, where it is easier for financial companies or mobile companies to aggregate consume SXER transactional data, significant and important restrictions and protections placed on access to patient data. As you all know, HIPAA restricts access to patient information, which is an important privacy safeguard.  However, the law also restricts some potentially useful uses of patient data, which may help to improve healthcare outcomes and lower the cost of treatment. One of the things I should have told my staff was to print this speech in a little bigger font, as I go through here for a moment. Yes, we got to protect patient personal data, but we have to look at where I know this is enormous can of worms, where some slight switches in HIPAA might take place because HIPAA I think does restrict patients from use Thanksgiving information that can drive down better healthcare outcomes and better cost containment.

Third, even if we could reach consensus how to best protect patient privacy, the healthcare sector currently has no economic incentives to share data. On the contrary, business models are centered around proprietary data. There are a lot of hospital systems here and providers, this gets into uncomfortable space, that you have created I think some of this, hospital systems in Virginia, where I've had brilliant presentations made because I am a bit of a telecom, and little bit 've of a tech geek, which is fairly low bar when you are in politics to get over. I like to say I was very current circa 2000, which still puts me a decade ahead of most of my colleagues, but, you know, I remember hearing a major healthcare system they just invested 120 million dollars in a remarkable -- a remarkable electronic health record patient record EHR system and then I made the mistake of asking, gosh, if you have a patient from a competing healthcare system or one of your patients goes to a competing healthcare hospital not in your network, can you share any of that information? I got this, you know, horrid look on his face saying, my gosh that, might mean that patient could become a customer of another system.

So into the day, we have to recognize that CMS has to actually accelerate its work to incorporate how we share reimbursements, how we allow and get the incentives right and this is one of the ones as a policymaker, I would like your ideas on how we get this circumstance right. Then finally, the dynamic nature of healthcare, one of the great secrets and I think you've seen in cell phones, that you have seen in credit cards, all goes back to the razor theory, you know, the razor business got ahead of this a long time ago. They exactly out with a fancy doodad razor that has all bells and whistles and sell it off at incredibly cheap price even today, they make their money is selling very expensive razor blades that go into the raisar. We've seen the same thing to a certain degree in cell phones, the same thing in credit cards, the same thing in computer technology, we're going to give you a whiz bang initial device and then we're going to make the money on your usage, updates and billing. You know, that is challenging in each of those fields, but exponentially more challenging in a field like healthcare, where the constant transformation of healthcare procedures, the constant transformation on billing procedures, on coding procedures means we're going to sell you an electronic health record system low price of $50,000, but where we make the money is on updates and monthly billing and accessories. We have to recognize that again is a challenge to having a truly robust interoperability system.

So my first and major point on this and I'm already getting cue cards here to wrap it up is that I absolutely believe that interoperability has to be the standard. We're 10 billion into this roughly 30 billion Federal investment, stage 2 is important.  Recognizing here around interoperability that perfect is good and let me also acknowledge tis easier to get Republicans and Democrats to agree than it is to get software engineers to agree.  (Laughter)

You know, on a common system. At some point, somebody's got to come in and say enough debate, the perfect is good, this is the standard and those of us from the policy standpoint have to back you up when everybody who invested in legacy system that aren't going to meet the new interoperability can't make the grade.

Second thing we need to continue to do is accelerated time frame for Meaningful Use. Again, we can't, we need to accelerate Meaningful Use, there are some in the house who are saying my gosh, we have not seen this transformation take place, let's cut this off. We're about 10 billion out in terms of Meaningful Use payments, we have 2 billion out in terms of healthcare systems that are talking about accountable care organization and interoperability, I believe we need to continue to put the pedal to the metal on Meaningful Use, but I fundamentally believe again in this area that in many ways what is pushing forward Meaningful Use more than anything and I've got great statistics on how much the Meaningful Use has increased here, but I can't read them with the type font, but we have seen it go up, but we've also saw and I think all of us who want you to be successful had a little bit of a chill when we read the New York Times story this past June that actually said healthcare IT was one of the biggest drivers of Medicare costs without the kind of ancillary and corollary benefits. So we got to get our data sets together. We got to have real numbers that show that just having Meaningful Use in legacy systems is not enough and frankly I believe that end of the day time is our best allie here as more and more people even doctors become competent on if not a computer, at least an iPhone, the value of being able to exchange patient data in a meaningful way and utilize that becomes a much less scary item and will become more and more the norm.

So I support what Farzad and the team are doing in terms of increasing Meaningful Use, but we have to do it again with this interoperability component in place.

Finally, we've got to think about a long-term strategy here. The long-term strategy is we think about new areas mobile apps, we think about the area I saw a friend of mine last night who has a new Nike wrist band that is kind of 21st century pedometers which I think will become all the rage in this holiday season.  We've seen the new Fibitz that go on your waist and measure activity. You know this, fits in healthcare IT. This is fwe're not careful, how we sync up all these systems in a patient friendly, user friendly way is part of the challenge in front of you.

I still fundamentally believe this -- the tool here that we are developing can be one of the most important in improving patient behavior, improving patient personal patient healthcare themselves and driving down costs. We also have to acknowledge that healthcare IT is a means to an end. It is not an end in itself. All the bells and whistles of individual systems, I saw the vendors out here, it is great, what are our in?

We want a healthier America, an America that is more fit and understands what we all have to do with individual responsibility. We want an America that better utilizes whether it's pharmaceutical drugs or whether it is medical devices in a way where they can measure their output.

We need a provider system that can help monitor and then encourage patient participation.

We need to make sure that we've got an ability to link so that we avoid the kind of duplication and mistake s that none of us like to acknowledge, but take place each and every day in our doctor's offices, in our hospitals, all powerful tool and we have to then find a way through health IT to build this out and charge for this in an efficient and effective manner that is appropriate. We don't get there and I say this again with respect when people simply say am, Meaningful Use, I can simply use cloning technique to get increase reimbursement rates. Nothing will do more to not only get the house, but frankly even your allies in the Senate, heads explode if we continue to see those kind of activities. We need an audit trail and a policing mechanism since end of the day, like it or not, increasing number of dollars are going to come from the Federal taxpayer to reimburse to get this right.

So I remain excited about the opportunity. I have a really exciting well thought through conclusion, three paragraphs here that I will put up at some point for those who want to read the speech online.

So instead I'll just say, hang in there, stay at it. Closing messages, perfect is the enemy of the good. We have to have interoperability sooner rather than later. We cannot retreat from Meaningful Use goals, but simply paying you for Meaningful Use without interoperability all it does is create a lot more legacy systems and third, I ask you to still dream big, dream big about how these tools get out of the doc's office, get out of the hospital and get on to the patient in a way that actually improves the quality and cost effectiveness of our healthcare system F. We do that, all of the potential that we thought about in healthcare IT, all of us who stood up during or argued quietly and publicly, yeah, we got to put real resources behind this, even in something as controversial as stimulus bill, we will see dramatic dramatic returns, but the ball is in your court. I and others are here to help. And I want to be supportive, but quoting that famous American, Ronald Reagan, I would simply say around healthcare IT and its potential, trust but verify. So with that Farzad, thanks for having me, I look forward to continuing to work with you for many months to come.


Dr. Farzad Mostashari
>> That is awesome. You know --

Sen. Mark Warner (D-VA)
>> Read the formal comments, I will leave it here. Thank you all.

Dr. Farzad Mostashari
>> I think the most impressive part of that was that he obviously didn't do it off his notes.

Sen. Mark Warner (D-VA)
>> Thank you all, good luck, everybody.

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